In her Business Day opinion, our CEO – Claudia Pizzocri – reflect on the recent ‘Operation Dudula’ protests that barred foreign nationals from accessing public health clinics, a deeply disturbing act that strikes at the heart of South Africa’s constitutional promise of dignity and equality.
This is not just a question of immigration or public service access. It is a test democracy and legal order. Access to healthcare in SA is not a privilege bestowed on the deserving few nor is it defined by one’s citizenship or immigration status . It is a constitutional right.
Reflections on Operation Dudula.
SA is once again confronted by a disturbing reality. On June 25 protesters affiliated with Operation Dudula targeted Hillbrow Clinic in Johannesburg, preventing foreign nationals from entering health facilities.
While the protest leaders described their actions as necessary to protect local community interests, the events on the ground represented a direct threat to order and justice while attacking the fundamental principles of legal rule.
Health access is not a privilege
At the heart of SA’s democracy lies a promise of universal dignity: every person in the country is entitled to life-saving healthcare. Denying migrants the right to medical care is more than xenophobic; it is unconstitutional. Section 27 of the constitution guarantees the right to access healthcare, regardless of status. When self-appointed vigilantes impose arbitrary checks or blockades, civic order is shattered and constitutional protections cease to function.
The 30th anniversary of the Constitutional Court, marked this month, offers a moment to reflect on that foundational promise. Sandra Liebenberg, HF Oppenheimer chair in human rights law at the University of Stellenbosch, noted in her anniversary address that the court’s evolving jurisprudence on socioeconomic rights has demonstrated a consistent concern for inclusion, accountability and the practical realisation of dignity.
That concern cannot be selectively applied. “The effectiveness of socioeconomic rights,” Liebenberg wrote, “depends on the responsiveness of institutions that mediate their delivery.” If the constitution recognises the right to healthcare as a right that must be protected in practice, not only in principle, then so too must those institutions act to protect that right for all, regardless of who stands at the clinic gate.
Scapegoating foreigners masks deeper fears and failures
It is too easy to target foreigners for what ails society. Migrants have become an easy and obvious scapegoat for policy failures that cannot be solved by singling them out: a dysfunctional health system, slow or nonexistent asylum processing, rocketing unemployment, overcrowded and underfunded state schools and hospitals, to name but a few. Illegal migration is a symptom of these challenges, not the cause of the disease. It is no wonder that society is seduced by populist blame: “others are the problem”.
Social media platforms are a dangerous echo chamber. The wave of comments after the Hillbrow incident reveals a toxic mindset: “Why should we pay for them?”, “If they don’t belong, they don’t deserve”. This reflects a wilful neglect of constitutional principles, in which undocumented status is misperceived as a licence to deny humanity and dignity. Equality becomes discretion. Some even argue that constitutional safeguards apply only to citizens and, worse, that extralegal exclusion is somehow acceptable. These narratives are false and dangerous.
Constitutional literacy should not be limited to academia and the courts
What the events at Hillbrow Clinic reflect, above all, is a profound erosion of constitutional literacy, not only among protesters but also among those entrusted with upholding the rule of law. When public officials, health administrators and even law enforcement operate in ways that suggest uncertainty about the constitutional obligations owed to every person in the republic, regardless of status, the vacuum is quickly filled by mob logic. That vacuum is not accidental and becomes institutional.
Constitutional literacy in SA has been treated for too long as the remit of courts and academics. But when section 27 rights can be disregarded at the gates of a clinic, and when the right to dignity is read as conditional rather than universal, it becomes clear that a technical understanding of the constitution is not enough. Its most basic principles must become operational knowledge across every level of government, every civil servant and every public-facing institution. What Hillbrow has exposed is the gap between legal principle and institutional practice.
From Europe to the US, similar cries of exclusion have taken root. SA has a sharper tool: a transformative constitution that unambiguously binds rights to individuals, not status. Yet that instrument is being tested on the ground by the complacent institutionalised xenophobic sentiment that has been allowed to fester for far too many years.
Clinic blockades: a warning sign
Hillbrow is not alone. What were once isolated protests have evolved into a structured, sustained pattern of exclusion. The strategy is twofold: exclude migrants from the most basic public goods and provoke an emotive political response.
Institutions cannot be passive observers in times of social crisis. Their own legitimacy is bound up with their ability to apply the law free from distortion. When they fail or fall silent, the architecture of law they are meant to safeguard becomes a negotiable commodity. The events at Hillbrow raise a broader question: what kind of state exists when access to fundamental services is determined not by law, but by sentiment at the gate?
The dangers of enabling vigilantism
In the words of NGO Accountability Now, “vigilantism and xenophobia thrive when the justice system … fail[s] the people”. In such a vacuum sentiments morph swiftly into actions, and civic space becomes contested ground. Clinics stop being safe havens and turn into theatres of exclusion. Borders cease to mark sovereign lines and become checkpoints of intolerance.
The rule of law depends not only on what rights guarantee, but also on who delivers them and how. If the state is unwilling or unable to discharge its constitutional obligations, it will be others who act to deliver their own versions of justice and order. That is how democracies fray. Even recent history, as seen in Sudan and the Philippines for instance, shows that when states abdicate their duty to uphold the law and instead tolerate or enable vigilantism, the consequences are profound: the rule of law erodes, institutions lose legitimacy, and democracy, where it exists, begins to unravel.
By Claudia Pizzocri, CEO at Eisenberg & Associates.